According to social psychologist Daniel Batson’s ’empathy-altruism hypothesis’, empathy drives people to help others out of a feeling of genuine concern for their wellbeing. If one feels a high level of empathic concern towards another individual, they are more likely to help them prosocially, irrespective of any self-interest concerns. (*32, *33) Empathy is an important component of Everett Worthington’s REACH (Recall – Empathize – Altruism – Commitment – Hold) model of forgiveness. (*34)

Briefly, the current concept of empathy found its roots in the German aesthetics term Einfuhlung (i.e., feeling into somebody), when it was used by the philosopher Robert Vischer for the first time in 1873, and was transliterated by Edward Titchener into Empathy in 1909. In between, Theodor Lipps introduced the German term into the field of social cognition and used it to indicate our capacity for understanding others.

Empathy is the experience of understanding and feeling another person’s condition from their unique perspective. A colloquialism that captures its core essence is: “I know exactly how you feel.” It is essentially a temporary, reflexive phenomenon, and one observes it primarily in retrospect. But it can learned as well. Finally, even though people literally feel ‘another’s woes’, they well maintain a separate identity of the self.

Empathy needs a distinction with sympathy, which is this: empathy is more about shared understanding, while sympathy is more about shared affect.

In the recent times, many psychologists have vouched for the idea that empathy is rather a multidimensional construct than a unitary experience. There have been forwarding of the various ideas: mirror empathy, motor empathy, affective empathy, cognitive empathy, behavioral empathy, reenactive empathy, etc. The author, here, agrees with the model proposed by Paul Ekman, a pioneer in the field of emotions and micro-expressions, that empathy can be of following three types –

Cognitive empathy or ‘perspective taking’ – the recognizing and understanding of another’s perspectives and feelings,

Affective empathy or ’emotional empathy’ – the vicarious sharing of feelings resulting from an emotional contagion, and

Compassionate empathy or ’empathic concern’ – the motor representation of the previous two, or a motivation to act after understanding and feeling another’s experience. (*31)

Eclectic Findings on Empathy

Empathy contributes to our happiness and wellbeing, irrespective of our age. Empathy has been found to be associated with a positive wellbeing and positive relations with others across a wide age range, from 10 to 87 years. Moreover, those with high empathy felt their social interactions were more meaningful, and made them and their interactive partners feel more positive. (*1) Anecdotally and empirically, empathy tends to be greater among older adults.

While most researchers agree on the positive role of empathy in interpersonal relationships, this appears to be most prominent in marital partnerships. Empathy directly predicts marital forgiveness and marital quality. (*2) However, there is a catch: Empathy is not thought of as being curative, as love is. While accurately inferring what is running on in the minds of one’s partner can strengthen the positive relationships, the very same attribute can end negative relationships. In contrast, love cures both.

There is evidence that certain brain regions (e.g. the anterior insula) and various hormones (e.g. oxytocin) are involved in parenting and empathy-driven prosocial responses (*21). It has also been postulated that mirror neurons (a set of neurons in the premotor cortex that fire when we observe another person performing an intention-driven activity, in the same way if we were to actually reenact the activity ourselves) are the neural basis for our ability to understand others’ actions. In brain, the Empathic Resonance occurs via communication between action networks and limbic areas provided by the insula. (*29) Mirror neurons enable us to understand other people’s actions in terms of our own movements and goals – to empathize with them. (*30)

People with tendency to depression are substantially empathic. It has been observed that mildly depressed people were the best scoring empathizers. (*5) An excessive empathy-based guilt might be an important evolutionary factor in depression and submissive behavior, as suggested by O’Connor et al. (2002).

Empathy can be exhibited by psychopaths, as contrary to common perception. Typically, a psychopath has been characterized as having a profound lack of empathy and remorse. But Christian Keysers et al. (2013) compared the brain activity of 18 psychopathic offenders on fMRI and found that when asked to empathize, the psychopaths appeared to show normal levels of empathy. (*6)

The everyday phenomena of ‘mind-reading’ and experiencing with ‘a sixth-sense’ is not a parapsychological phenomenon, but Empathic Inference, which involves an interplay of knowledge, reasoning, observation, and memory. (*3) And, women do not have superior intuitive abilities (Empathic Accuracy) than men, despite being culturally stereotyped for the same throughout history, as established by Klein and Hodges, 2001. (*4)

New Findings on Empathy

Rather than carrying out a rigorous critical review, the author decided to ‘take a look’ at some of the published literature on empathy between January 2014 and August 2015. While this exercise may not seem as a groundbreaking attempt to derive or establish new or previously unobserved conclusions, this certainly strives to provide the reader with ‘a ring-side view of what has been up of late’ on empathy.

I. Neuroimaging Into Empathy

While we already know the role of mirror neurons in expression of empathy, and that it was established by Nummenmaa, et al. (2008) that emotional empathy engaged the mirror neuron system (premotor cortex) more than cognitive empathy (*7), we looked into the latest neuroresearch.

Neuroimaging studies by Goerlich-Dobre, et al. (2015) identified that the left amygdala was the key substrate for both alexithymia (“no words for feelings”) and empathy. They concluded that the empathic capacities are linked to larger left amygdala volume, whereas the opposite – smaller volume – was linked to alexithymia. (*8)

Kanske, Böckler, et al. (2015) presented EmpaToM – a novel fMRI paradigm that independently manipulates both empathy and theory of Mind (ToM) – to reveal that two distinct neural networks functioned in our brains: the anterior insula for empathy, and the ventral temporoparietal junction for ToM. Their finding allows the neuronic separation of affective and cognitive routes in our social brain, and may direct future clinical and interventional studies. (*9)

Robert Eres et al. at Monash University (2015) used voxel-based morphometry (VBM) to demonstrate that people with high scores for affective empathy had greater gray matter density in the insula, while those with high scores for cognitive empathy had greater density in the midcingulate cortex and adjacent dorsomedial prefrontal cortex (MCC/dmPFC). They infer that these findings validate the theory of empathy being a multi-component construct. (*10)

Hortensiusa & Geldera (2014) tried to explore the neural basis of bystander effect (empathy deficit in the bystanders towards the victim) and its relationship to group size in emergency. Their fMRI scans showed that as the group size increased, there was decreased activity in the brain regions associated with action preparation (left precentral, left postcentral, and left mediofrontal gyri). (*16)

II. Empathy Among Strangers

Empathy is stronger among in-group members (people seen as similar to selves), and weaker among out-group members (strangers). This barrier to expressing empathy in presence of unfamiliar people is called Empathy Gap.

Martin et al. (2015) demonstrated that empathy gap can be reduced by eliminating the stress of social interaction with strangers via introducing an emotional contagion (a form of empathy). In their experiment that included rodents as well as humans, they let the human strangers go through a shared gaming experience (specifically, the music video game Rock Band) to block the endocrine stress response, and thus introduce an emotional contagion. When asked to submerge their arm in ice-cold water and rate their pain before and after the game sharing, the participants recorded feeling more pain in the latter case when they sat across from a ‘friend’. They concluded that while stress from the presence of strangers prevents empathy, a shared experience (even as cursory as playing a game together on Xbox or PlayStation) can generate meaningful levels of empathy between them. (*12)

The bullies use cognitive empathy to their advantage: to manipulate, exploit, or to control others.Cyberbullying or virtual bullying or ‘trolling’ – which includes bullying over various digital platforms, as online social media, emails and messaging services – is on a steady rise. Pew Research Center (2014) found that 40% of adult internet users have personally experienced some variety of online harassment, while 73% have witnessed it happen to others, among a sample of 3,217 adult internet users in United States. (*13)

One of the most effective strategies to counter cyberbullying is taking of responsible action by the “cyberstanders”, such as challenging the bully (confrontational) or siding with the victim (supportive). While empathy encourages bystanders to intervene, bystander Empathy Deficit in cases of online bullying remains a veritable problem. Shultz, Heilman, and Hart (2014) explored how online bystanders responded when presented with a cyberbullying simulation using Facebook, and found that even though 91% of the participants identified bullying, the bystander response rate was dismally low (barely 31% and 47% reported that they would use supportive methods for the victim), in line with previous studies by Li (2010) and Tokunaga (2010). Unsurprisingly, they also found that individuals who identified with the victim had higher empathy scores than those who identified with the bullies. (*14)

Diffusion of Responsibility is a mechanism which often explains why in a real attack situation (prosocial or antisocial), the greater the number of bystanders present, the lesser likely they are to help the victim in distress. Hana Machackova et al.(2015) checked if this behavior held steadfast in cyberbullying cases too. They studied self-reported data from 257 Czech witnesses of a cyberbully attack and found that the online group size mattered equally same as in ‘real world’ situations: people tended to help the cyber-victims more in incidents involving only 1 or 2 other bystanders. (*15)

III. Antisocial Behavior and Empathy

Cognitive empathy can be elicited at will in psychopaths (intentional capacity to empathize), as we briefly discussed above. They exhibit empathy only when specifically asked to do so, as opposed to spontaneously as the rest of us naturally do. However, a point to be kept in note is that a lack of empathy does not automatically imply a desire to harm.

Decety, Skelly, Yoder, & Kiehl (2014) found that high-scoring psychopaths had consistently less activation in the core face-processing neural network including the fusiform gyrus, occipital cortex, and parts of superior temporal sulcus, while viewing video clips of four facial expressions – happy, sad, fear, and pain. This points to a new finding that psychopaths actually have a empathy deficit that is pervasive across the range of these four emotions, rather than only for fear as usually perceived. It was also a surprise to find that the high-scoring psychopaths showed significant amygdala response to most expression categories (except the right amygdalar response to happy/sad faces), just as similar to low-scoring control subjects. (*11)

Saima Eman presented a paper at the IAFOR North American Conference on Psychology & the Behavioral Sciences (2014) on a study that she and her colleagues conducted – an online survey of 540 undergraduate students between 17 and 25 years of age – exploring the role of sensation seeking and empathy subtypes in antisocial behaviors. They concluded:
• high sensation seeking with low emotional reactivity predicted physically aggressive behaviors,
• high sensation seeking with low social skills predicted physically aggressive behaviors,
• low sensation seeking with low social skills predicted non-aggressive behaviors,
• high sensation seeking with low cognitive empathy predicted non-aggressive behaviors,
• low sensation seeking with high cognitive empathy predicted non-aggressive behaviors. (*17)

MDMA is a psychoactive drug, popularly called “ecstasy”, that is illegally used as a recreational agent in “rave” parties primarily for its purported euphoria causing and empathy enhancing effects. Recently, there was a post on Reddit – an online bulletin board – asking if “MDMA (ecstasy) be renamed as empathy?” MDMA and its related phenethylamine derivatives are often classed as Empathogens – a term coined in 1983-84 by Ralph Metzner and David E. Nichols to represent the drugs that increase feelings of empathy and social connection. Anecdotal evidence from the late 1970s point toward MDMA being able to to accelerate psychotherapy by increasing empathy and self-compassion. Hysek, Schmid, et al. (2014), in a first study of its kind, found that MDMA enhances explicit and implicit emotional empathy, and prosocial behavior, mainly in men. However, it did not alter cognitive empathy. (*18) Presently, the non-profit Multidisciplinary Association for Psychedelic Studies (MAPS) is funding pilot studies to investigate its therapeutic usefulness in PTSD. Their estimated study completion date is in November 2015 (*19). However, it must be stressed that it has no accepted medical uses, and possession of any amount of MDMA is illegal, the only exception being restricted use in scientific and medical research.

Aggression and empathy have been called “existential twins” by Jesper Juul, the Danish family therapist. Juul holds the view that empathy is the best counteractant for aggression. While high empathy may reduce aggression when there is a personal threat, contrastingly, it may actually aggravate a person’s anger when the threat is directed at their loved ones. Significantly, empathy has been a core component of non-pharmacological therapy interventions of aggressive behavior. However, this established approach was threatened by a study by Vachon, Lynam & Johnson (2014) who found that the relation between empathy and aggression was strikingly weak, and this weakness in the link was fairly constant over verbal, physical, and sexual aggression. This points to a new era of review of the current trends in anger management involving training in empathy. (*20)

IV. Empathy in Medical Profession

Medical personnel, such as physicians, nursing professionals, and other paramedical caregivers, are among the most empathic professionals. Clinical empathy has always been valued as a fundamental requirement in patient-doctor relationships, even before the advent of modern medicine. In present times, high empathy has been shown to increase patient satisfaction, clinical competence (*22), and treatment compliance (*23). But it has also been shown that experience seems to desensitize physicians to the others’ pain. As years go by, with gathering of professional experience, the clinicians start scoring low on empathy. (*24, *25).

Being continuously exposed to the suffering and the distress of patients, they are quite prone to burnout, compassion fatigue, and empathy fatigue, which can then have significant adverse effects on their wellbeing, as well as on the quality of patient care. ‘Burnout’, a term coined by the psychologist Herbert Freudenberger, refers to the triad of emotional fatigue, depersonalization, and diminished self-value, caused by long-term occupational stress. ‘Compassion fatigue’ is a state of secondary traumatization or ‘second-hand trauma’ experienced by many healthcare professionals that is acquired through interacting with their patients’ multiple traumatic experiences, causing them to exhaust their ability to empathize with, or care for, others. ‘Empathy fatigue’ is a phrase coined by rehabilitation counselor Mark Stebnicki, which implies a state of debilitation that causes decline of the counselor’s resiliency, coping and empathic abilities, as a result of the counselors’ own wounds being “continually revisited by their clients’ life stories of chronic illness, disability, trauma, grief and loss”.

Burnout has been called “empathy killer”. Brazeau & Schroeder et al. (2010) had observed that the higher the medical student’s burnout rate, the lower their ‘clinical empathy’. (*36) Disturbingly, its occurrence among medical professionals has been rising over the years. Burnout literature points towards its presence in medical students (28%–45%), medical residents (27%–75%), and practicing physicians (30%–70%). Fadi Jan and Mohammed Jan (2015) carried out a cross-sectional study involving 60 pediatric residents of mean age 26.5 years across Jeddah, Saudi Arabia, and found that burnout scores (using Maslach Burnout Inventory) were abnormal in 82%, and severe in 32%. It was also revealed that age, marital status, and income had no correlation with burnout states, and was more common among males. (*35)

Many studies have established in the past that empathy can be taught to various groups of people. (*26) But the question often asked is, “Can the doctors be taught empathy?” The answer is a reassuring “Yes!” Three recent studies has confirmed this among the healthcare professionals. Williams, Brown, McKenna, et al. (2015) showed that self-reported empathy scores of 293 students from 12 different medical and health care professions improved significantly after a video simulation-based empathy workshop. (*27) Cheung & Reeves (2014) evaluated a 10-week course titled “Compassion in Medicine” among pre-health undergraduate students at the University of California Irvine, and found that the participants recorded significantly higher scores after the course on Jefferson Scale of Physician Empathy (JSPE). (*28) Potter, Pion, and Gentry (2015) undertook a compassion fatigue resiliency training program for 15 participants, and found that at nine months after course completion, all of them reported regular application of one or more of the resiliency skills taught to improve their ability to manage stress and prevent compassion fatigue and burnout. (*37)

It had been questioned if a high degree of empathy itself leads to compassion fatigue. Then, “Should the physician avoid empathic behavior to prevent burnout and compassion fatigue?” This was answered by a first-of-its-kind study that investigated the patterns of empathy in relation to burnout in general practitioners. Lamothe et al. (2014) found that whereas a higher level of perspective taking (cognitive empathy) was predictably associated with a lower burnout, however, a higher level of empathic concern (compassionate empathy) was also noticeably associated with a lower burnout. Further, their study revealed that physicians who scored high on perspective taking, or empathic concern, or both, had considerably lower risk of experiencing burnout, with those with high levels of both types of empathy scoring the the lowest burnout percentages. (*38)

Schroeder & Fishbach (2015) wrote a paper title curiously ‘The ‘‘Empty Vessel’’ Physician’. In this, they brought forth the results of their 6 studies on how the patients perceive their doctors, rather than the other way around. They finally concluded that patients believe and expect their physicians to be like ‘‘empty vessels’’ – devoid of personal emotions. This finding could direct the physicians towards a new discussion on modern-day pertinence of their traditional empathic approach to patients. (*39) Haque & Waytz (2012) had showed that a failing to acknowledge an individual’s mental state could adversely tilt the empathic balance and make them feel dehumanized. (*40), which, when taken into account, can eventually have a negative effect on, at least partially, the quality of patient care.

Conclusion

While Empathy has rightfully found its place under the sun, the author feels that it has stolen the thunder from Sympathy. In common parlance, today, sympathy has almost been relegated to mean expressing sorrow at someone’s misfortune. Sympathy originally meant a feeling of compassion towards another. Sometimes, it meant crying together with a grieving friend without trying to understand what could be going through their mind or telling them that you know how they feel. Because we cannot exactly feel the way they feel, however much we try, as pain is an intensely personal experience. And they never needed us to have gone through their experience sometime in our lives to be sitting with them and feel genuinely sad with them.

Some postulate that Sympathy can be synonymous with Batson’s Empathic Concern. This could give us a clue to what we can look forward to in the coming years.